Cleft lip and palate infant feeding

Babies spend much of their
time feeding. To feed well, they need to position their lips
and tongue around the nipple or artificial teat, and create both
suction and compression during sucking.

Sucking is more difficult when a baby is born with a
cleft palate or combined cleft lip and cleft palate. There are a number of ways to help these babies
feed well.

Cleft lip

Babies born with a cleft
lip alone usually feed well. Some babies breastfeed better with the
cleft facing upwards. The breast tissue usually fills the gap where
the cleft is and allows efficient feeding. Some bottle fed babies
feed better on a wide based teat.

Cleft palate

Babies with cleft palate
often look like they are feeding well because the lips and tongue
close around the nipple or artificial teat like non-cleft babies
and the jaw moves well during sucking.

But most babies with cleft
palate cannot generate suction during feeding. The lack of suction
makes it difficult, and for some babies impossible, to breastfeed or
drink from a bottle efficiently. Consequently, feeding can take a long time
and is tiring for the baby who may not get enough milk to grow and
develop well. Help is available to manage these feeding
problems.

Cleft lip and
palate

Babies with cleft palate
can't create enough suction during feeding to draw milk from the
breast or bottle easily. This is because air leaks from the mouth
through the cleft into the nose during feeding. If the baby also
has a cleft lip he/she may not be able to compress the breast or
teat well enough to push milk from the breast or bottle.

In either case, feeding is
usually slow and tiring and the baby may not drink enough to grow
well. These problems are usually solved by using teats and bottles
especially designed for babies with cleft palate. Your cleft
coordinator can show you the different bottles and teats available
and demonstrate how to use them.

Your local pharmacy
(although you may need to make a special order if using your local pharmacy).

Breastfeeding

Breastmilk is best for
babies. When babies can't feed well directly from the breast, mothers may choose to feed their baby expressed breastmilk (EBM) from a
bottle. Lactation consultants and Maternal and Child Health Nurses are able to provide specific advice and support to new
mothers who wish to express breastmilk for their baby.

Bottle feeding

There is no need to use the equipment described below if your baby feeds well
from a standard teat or bottle bought from a supermarket or
pharmacy.

A number of special teats
and bottles are available for babies who cannot generate suction
and/or compression during feeding. They come in different
shapes and sizes and have several features in common.

The bottle (or in the
case of the Haberman feeder, the teat) can be squeezed while the
baby is sucking. This pushes milk into the baby's mouth and
compensates for the lack of suction.

The teat often has a
one-way valve which keeps it full of milk. This is helpful for
babies who can compress the teat but can't generate
suction. It is also thought to minimise wind.

The teat often has a
'cross-cut' rather than a hole in the end. This stops milk
dripping into the baby's mouth when they have stopped for a rest
during feeding.

Feeding tips

Each baby is unique so
different techniques will suit different babies even if they have
the same kind of cleft. However, some general tips are:

Feed your baby in a calm quiet environment.
Make sure you are sitting in a comfortable chair.

Seat your baby fairly upright for bottle
feeding. This may prevent milk coming out of your baby's nose during sucking. Hold your baby
close to you so he/she is well supported during feeding.

If your baby also has a cleft lip, avoid
placing the teat into the cleft.

Once your baby starts sucking, squeeze the
bottle gently to deliver milk into the mouth. If you are using the
SpecialNeeds® Feeder (Haberman), the teat rather than the bottle
should be squeezed. A squeeze every 3 - 4 sucks is usually
enough.

Some mothers find it helpful to practice
squeezing a water-filled bottle to get an idea of how the flow changes with more rapid squeezing or stronger
squeezing of the bottle.

Watch how your baby
reacts to the pulsing or prolonged squeezing of the bottle. If the
baby looks uncomfortable or is not managing the mouthful of milk, stop squeezing and let your baby rest and swallow before more milk
is given.

Have several breaks for
burping, as your baby may be more 'windy' than usual.

Keep each feed to 20-30
minutes. Longer feeds mean your baby will use too much energy
during feeding. This can make weight gain difficult.

Newborn babies can lose
up to 10% of their birth weight but usually regain it in two to three weeks.
If your baby is having five or six wet nappies per day, regular bowel motions and is healthy and alert, then it is likely that he/she is feeding
well. Slow weight gain or weight loss may mean the feeding method
needs to be changed.

Some babies have serious
feeding problems (dysphagia) which mean they need specialised help
to manage feedng. The RCH speech pathologists can help.

Feeding your baby after
cleft lip or cleft palate repair

Your plastic surgeon will
give specific instructions on how to feed your child in the first
few days after the surgery to repair the lip or palate. In
general, babies are encouraged to return to their usual method of
feeding (breastfeeding or bottle feeding) after surgery. If
the baby has progressed to solids, these can also be
reintroduced quite quickly after palate repair surgery. The food should be a soft, 'sloppy' consistency for the
first three weeks.

Introducing
solids

Babies with cleft palate or cleft lip and
palate usually start taking solids at the same time as other babies
(usually around six months).

Sometimes food may come out through the
baby's nose during feeding. This may improve if you sit your baby more
upright or make the food a little runnier. If problems persist, you
can contact the speech pathologists for advice.

Where to get teats and bottles

You can get bottles and teats from The Royal
Children's Hospital Equipment Distribution Centre or
CleftPaLS. Contact details for both are listed below.

Some commonly used teats and bottles

The SpecialNeeds® Feeder: Previously known as the Haberman feeder, this has a long narrow teat which is
squeezed during feeding to release milk into the baby's
mouth. The teat has a 'slit' cut and allows slow, medium or
fast flow depending on the orientation of the 'slit' during
feeding. The teat also has a one-way valve to minimise
swallowing of air, and maximise response to compression.

Queensland CleftPALS
Bottle: This is a soft polythene bottle made by Queensland
CleftPALS Inc. It works well with a number of different teats and
is gently squeezed during feeding to assist the baby in receiving
milk.

Pigeon Cleft Teat: This is
an isoprene rubber teat that can be used with a squeeze bottle or
a normal rigid bottle. It comes with a plastic regulator that can
be inserted into the teat to assist with milk flow. The thicker part of the teat must be facing upwards (towards the roof
of the mouth) for efficient feeding.

Chu Chu Easy Feed Teat: This is a silicone rubber teat (nitrosamine free), that can be used
with a squeeze bottle or normal bottle. When feeding, ensure the
flat part of the teat is facing upwards (towards the roof of the mouth).

Chu Chu Cross-cut Teat: This is an isoprene rubber teat (nitrosamine free) with a cross cut
in the top. It can be used with a squeeze bottle or normal
bottle.

CleftPaLS (the Cleft Palate and Lip
Society)www.cleftpalsvic.moonwurx.comCleftPaLS is a parent group that offers support and information to families.
Members of this group are happy to visit new parents in hospital. They provide telephone contact and are available at any time.
There is a branch of CleftPaLs in each state - the Victorian
contact telephone number can be found in the White Pages under
Cleftpals. CleftPaLS provide information packs for
expecting and new parents and also supply a range of bottles and
teats for babies who are unable to breastfeed or bottle feed using
conventional teats and bottles.

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Disclaimer This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.